War Against Cancer: A Long, Hard Slog

Between 1950 and 2005, the U.S. death rate for heart disease fell 64%, adjusted for the age of the population, and the death rate for flu and pneumonia fell 58%. During the same time period, the age-adjusted death rate for cancer fell only 5%.

That’s despite more than $100 billion in cancer-research spending since the early 1970s.

Those are the key figures in a front-page story in this morning’s New York Times describing the long, hard slog that started with Richard Nixon’s war on cancer.

Yes, there are some success stories. But cancer is a complex disease that remains largely untreatable for many patients. There are vast differences between different types of cancer, making it unlikely that a single “cure for cancer” will emerge to defeat the disease.

Last year, we noted a similar article that appeared in Newsweek and quoted an oncologist and cancer survivor who questioned the very language used to discuss the disease.

“The metaphor of fighting cancer implies the possibility of winning,” the oncologist said. “With cancer, sometimes death is not optional.”

Comments (5 of 5)

The assumption is that mutated genes somehow either cause cancer directly or inactivate genes thought to guard against cancer, the so-called oncogenes and tumor suppressor genes. However, there is no functional proof that the gene mutation theory is correct. The assumption that the pathways of tumor cells can be known in a patient with metastatic cancer is logically inconsistent with the reality of tumor cell evolution. The problem is that a patient with metastatic cancer can have billions of unknown cancer cells disseminated throughout the body at unknown locations. Each cancer cell can be different. And the cancer cells that are present change and evolve with time. Even if cancers are from the same tissue, and are generated with the same carcinogen, they are never the same. There is always a cytogenetic and a biochemical individuality in every cancer.

6:32 pm April 26, 2009

PNHP Doc wrote :

With single payer interstate health insurance based on Medicare, true oncologic clinical outcomes would be analyzed and made available for researchers and the public. Both physicians, clinics and hospitals could be rated on their survival, cure, lifespan and associated morbidity and mortality rates. Referrals could be made to doctors, clinics and hospitals based on quality instead of just pictures of smiling doctors in white coats claiming to be the 'best in town'. Real time outcome research made possible by a single integrated EMR and billing system under single payer Medicare for All (HR676, S703) would identify and accelerate efficacious treatments and associated problems. Right now, with only retrospective and prospective published clnical analysis available, any data which is utilized in the clinic is by nature at least 3 years old and already outdated.

10:54 am April 26, 2009

A surgeon wrote :

Tin-foil had a little loose there Dave? HIV denial not keeping you busy full time?

Cancer(s) have proved to be difficult problems because the biology to understand them has been a long time coming. In those cases where we understand the mechanism, and in a couple where we probably don't, the treatments are astoundingly successful. A few examples:

1. Virtually all widespread germ cell tumors are cured with modern chemotherapy. Why platinum based chmotherapy works is not yet understood.
2. Gleevec, a well tolerated orally available drug, speciifically targets the MUTATION that causes most CML and GIST tumors. It is a miracle drug.
3. Gardasil, a vaccine, prevents cervical cancer, known now to be caused by MUTATIONS induced by certain strains of HPV when they integrate into the DNA of cervical cells.

9:01 am April 26, 2009

David Rasnick, PhD wrote :

As Max Planck said, science progresses one funeral at a time. What is needed is new thinking, not more money. We will soon see if Planck was right, for the old guard of mutant gene researchers is indeed getting old. It is encouraging to see that a new generation of cancer researchers are more inclined to consider alternatives to the gene mutation hypothesis of cancer.

David Rasnick, PhD

9:06 am April 25, 2009

Patriot wrote :

Has there been real progress in the treatment of the most common forms of cancer? Three decades of prospective, randomized trials in literally hundreds of thousands of patients have, in most cases, failed to define most optimum treatment regimens. NCI data has shown that U.S. cancer mortality rates have increased and age-adjusted cancer mortality rates in response to treatment have not improved in several decades, despite the introduction of many new drugs.

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This is an indictment of the cancer "investigator" culture, which prizes the exhaustive examination of trivial hypotheses, while eschewing support of cancer "discoverer" type research, attempting to create entirely new paradigms of cancer treatment that, when taken together, describes a dysfunctional cancer culture that pushes tens of thousands of physicians and scientists toward the goal of finding the tiniest improvements in treatment rather than genuine breakthroughs that rewards academic achievement and publication over all else.

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Investigators rely on models that are consistently lousy at predicting success, to the point where hundreds of cancer drugs are thrust into the pipeline, and many are approved by the FDA, even though their proven activity has little to do with curing cancer. The "models" for cancer treatment (e.g. mouse models, established cell line models, molecular mechanisms) have limited relevance to drug activity in real human cancer.

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What important "progress" may occur will likely come from "radically" new drugs, rather than from countless iterations of trials to fine tune the administration of the old drugs. I believe the advances in the treatment of advanced cancer are owing much more to improved surgical and radiation technique and that progress in the most important forms of cancer with regard to drug selection has been negligible and grossly overstated.